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State/federal cooperation

Feb 28, 2014 - By Steven R. Peck

It works well enough on highway funding, which could be a model for Medicaid as well

Wyoming legislators are still tossing around the idea of finding a way to expand Medicaid in Wyoming, which would be a good thing for as many as 17,000 residents -- many of them voters.

A bill not quite saying the state wants to do it, but leaving open the possibility, was surviving as of Friday at the Capitol.

The political implication of doing something that might even give the appearance of cooperating with President Barack Obama and the Affordable Care Act, which the expansion of Medicaid would do, has been mentioned before, as has the state's settled-upon objection to doing it, namely that "the federal government can't be trusted" to follow through on its end of the bargain.

The Affordable Care Act, which is the federal law of the land, says that states which expand Medicaid can pass the costs of doing it on to the federal government for the first year, with a large percentage of it covered by the feds after that for several years. Our state's own director of the Wyoming Department of Health says the savings could be in the $50 million range for the state.

The top brass has not embraced the financial benefit, focusing instead on the "can't trust the government" idea as its central talking point in opting not to do the expansion. But the existence of the bill seeking to find another way to cover the poor shows that they aren't entirely comfortable with not doing it.

Perhaps the state's leaders know something the rest of us don't about this particular pledge by the federal government, but the fact is that the state relies on federal funding assistance for many things on a daily basis, with nary a problem.

One example is the state-federal cooperation on highway funding. The state collects a federal tax on every gallon of gasoline sold in Wyoming. The money is forwarded to the United States Highway Trust Fund, which then makes it available to states to pay for the upkeep and, sometimes, expansion of federal highways in the states.

The highway fund is a federal program administered in part by the states. It isn't perfect (name a federal program that is), but it works well enough most of the time.

Medicaid can be looked at in the same way to a large extent. It, too, is a federal program administered by the states.

With "Obamacare" under intense, often critical, scrutiny day after day, the federal government would run an enormous risk if it were to renege on its commitment to fund the expansion. That in itself would seem to be something of an insurance policy against any federal back-out of the pledge. The last thing the Obama administration needs is to make available another angle for attack from a red state that already dislikes the health care law.

Would expanding Medicare in Wyoming actually lower health care costs overall due to better prevention, immunization, prenatal care and fewer unpaid emergency room visits, as ACA advocates claim?

It might be nice to find out. Their deep political and philosophical objections to the new law notwithstanding, the bill in the Legislature shows that our lawmakers haven't given up on the idea completely -- nor should they.